From the Guidelines
The recommended treatment for scabies is permethrin 5% cream applied to the entire body from the neck down, left on for 8-14 hours, then washed off, as this has been shown to be effective in killing the Sarcoptes scabiei mites that cause the infestation 1. This application should be repeated after 7-10 days to kill newly hatched mites.
- Alternative treatments include ivermectin (oral medication, typically 200 mcg/kg, repeated after 1-2 weeks), crotamiton 10% cream, or sulfur ointment.
- All household members and close contacts should be treated simultaneously, even if they don't have symptoms, to prevent reinfestation.
- Additionally, bedding, clothing, and towels used within the past 3 days should be washed in hot water and dried on high heat. Scabies causes intense itching that may persist for 2-4 weeks after treatment due to an allergic reaction to the mites, so antihistamines or topical steroids may be needed for symptom relief, as noted in the management of scabies guidelines 1. It's also important to note that crusted scabies, a more aggressive form of the infestation, may require combination treatment with a topical scabicide and oral ivermectin, as outlined in the guidelines for crusted scabies 1. In terms of other management considerations, bedding and clothing should be decontaminated, and persons with scabies should be advised to keep fingernails closely trimmed to reduce injury from excessive scratching 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: SHAKE WELL BEFORE USE. In Scabies: Thoroughly massage into the skin of the whole body, from the chin down, paying particular attention to all folds and creases. A second application is advisable 24 hours later. PRECAUTIONS General Scabies infestation is often accompanied by pruritus, edema, and erythema. Treatment with Permethrin Cream, 5% may temporarily exacerbate these conditions.
The recommended treatment for scabies is:
- Permethrin Cream, 5%: Apply to the whole body, from the chin down, paying particular attention to all folds and creases. A second application is advisable 24 hours later.
- Crotamiton (TOP): Thoroughly massage into the skin of the whole body, from the chin down, paying particular attention to all folds and creases. A second application is advisable 24 hours later. Key points to consider:
- Treatment may temporarily exacerbate pruritus, edema, and erythema.
- Patients should be advised to avoid contact with eyes during application and to flush with water immediately if the medication gets in the eyes.
- A cleansing bath should be taken 48 hours after the last application 2, 3.
From the Research
Treatment Options for Scabies
The recommended treatment for scabies includes the use of insecticides such as permethrin and ivermectin.
- Permethrin 5% cream is considered one of the most effective treatments for scabies, with a cure rate of 92.5% after two applications with a 1-week interval 4.
- Ivermectin is also effective, with a cure rate of 85.9% after a single dose, which increases to 100% after crossing over to the permethrin group at a 4-week interval 4.
- A study comparing permethrin and ivermectin found that twice application of permethrin with a 1-week interval is superior to a single dose of ivermectin 4.
Application and Dosage
The application and dosage of permethrin and ivermectin can vary.
- Permethrin 5% cream can be applied once daily for two consecutive days, with a cure rate of 87.2% 5.
- Ivermectin can be applied topically, with a dose of 400 μg/kg, repeated once the following week, with a cure rate of 64.7% at the 2-week follow-up 6.
- The application of permethrin 5% cream from neck down is commonly recommended, but some cases may require scalp-to-toes application, especially in infants and older adults with scalp involvement 7.
Comparison with Other Treatments
Permethrin and ivermectin have been compared to other treatments for scabies.